Empathy is a personal and professional attribute which has been widely associated with effective interpersonal functioning. The lack of empathy has been connected with the burnout phenomenon and with the consequences of early childhood trauma, such as child abuse. Although helping professionals might logically be expected to have high levels of empathy, this assumption is not usually supported by research and empathy has been reported to decline with increasing professional education and experience. Possibly the clinical experiences confronted by nurses (and some other health professionals) are psychologically traumatic and lead to the development of defenses against empathy. This study is proposed for the purpose of examining possible direct and interaction effects of nurse defensive style and client emotional state on selected measures of nurse empathy and clinical assessment skill. A factorial design, balanced for level of defensive style and interview condition, will be used to examine effects of nurse defensive style and situation on registered nurses' communication, physiological response, self and client ratings of empathy, and clinical assessment skills. A preliminary mailed survey of registered nurses living in the immediate geographical area will be used to obtain a pool of consenting subjects with high, medium, and low scores on the measure of defensive style (Byrne's revised repression-sensitization scale) (R-S). Thirty subjects will be randomly selected from each of the R-S groups and randomly assigned to one of three interview conditions with a drama student enacting the role of a woman about to have a mastectomy. The interviewee will present the same situation with different emotional conditions (affectively neutral, anxious and fearful, and overtly angry). Physiological monitoring and videotaping will be used to collect data during the interview. Multivariate analysis of variance will be used to examine effects of interview condition and defensive style on change in baseline physiological measures, external ratings of communication in filmed interview segments, post-interview empathy ratings by subjects and actress-clients, and effectiveness of the subjects' post-interview assessments of clients. Additional data analysis will include regression procedures to examine hierarchical relationships among the variables and hypothesis-generating exploratory analysis. Support of the conceptualization would suggest a number of potential mechanisms for improving the competence of nurses in clinical situations in which threatening stimuli are presented.
